Devices, systems, and methods for physiology monitoring

ABSTRACT

Software applications, devices, systems, and methods are provided for monitoring, recording, and tracking cardiac health related metrics using an associated computing device. The software applications may monitor, record, and track physiological data such as cardiac electrical activity, heart rate, and blood pressure. Data transmission between a patient and a healthcare provider may also be enabled via the software applications disclosed herein.

CROSS-REFERENCE

This application is a continuation of U.S. patent application Ser. No.15/692,831, filed Aug. 31, 2017, and titled “DEVICE, SYSTEMS, ANDMETHODS FOR PHYSIOLOGY MONITORING”, which claims the benefit of U.S.Provisional Application No. 62/382,227, filed Aug. 31, 2016, and titled“SOFTWARE APPLICATIONS, SYSTEMS, AND METHODS FOR PHYSIOLOGY MONITORINGDEVICES”. The disclosures of these applications are herein incorporatedby reference in their entirety.

BACKGROUND

The use of smartphones, tablet computers, wearable computers, and“smart” accessories is becoming increasingly prevalent. Smartphones arealmost ubiquitous in high income countries and are increasingly popularin middle and low income countries as the costs of production decreaseand Internet access becomes more available. This increased prevalence ofcomputing power and devices offers many opportunities for improved waysof monitoring health and placing health management more in the controlof the patient.

Cardiovascular disease is a leading cause of death in the world and isprevalent in the populations of high-income and low-income countriesalike. Heart rate measurement, blood pressure measurement, andelectrocardiography are widely used techniques for diagnosing thecardiovascular health of a patient.

SUMMARY OF THE DISCLOSURE

Described herein are software, systems, devices, and methods for linkinga patient with a healthcare provider for the purpose of providingeffective healthcare to the patient while increasing the efficiency ofthe healthcare provider. Software as described herein, in someembodiments, comprises one or more integrated applications on a singleplatform that connects a patient with a healthcare provider.

Described herein is a platform comprising: a patient applicationcomprising: a software module for receiving sensed data from a sensorconfigured to sense a physiologic parameter of a patient; a softwaremodule for transmitting one or more of the sensed data and a patientcommunication to a healthcare provider; a software module for receivinga healthcare provider communication; a healthcare provider applicationcomprising: a software module for receiving one or more of the senseddata and the patient communication; a software module for generating thehealthcare provider communication and transmitting the healthcareprovider communication to the patient; wherein the healthcare providercommunication is automatically generated and transmitted in response toone or more of the sensed data or a patient communication thatreferences the sensed data; wherein the healthcare providercommunication references the sensed data; and wherein the healthcareprovider communication includes an indicia that the healthcare providercommunication was generated by the healthcare provider. In someembodiments, the physical parameter comprises a vital sign of thepatient. In some embodiments, the physical parameter comprises a heartsound of the patient. In some embodiments, the patient communication istransmitted around a time that the physical parameter is sensed. In someembodiments, the patient communication comprises an audio recording ofthe patient. In some embodiments, the patient communication comprises avideo recording of the patient. In some embodiments, the patientcommunication is recorded and transmitted to the healthcare providerapplication in real-time. In some embodiments, the platform comprisesthe sensor and wherein the sensor is configured to operably couple witha mobile computing device. In some embodiments, the sensor is integratedwith the mobile computing device. In some embodiments, the sensorcomprises two ECG electrodes. In some embodiments, the healthcareprovider communication comprises a message of encouragement orcongratulation that is personalized to the patient. In some embodiments,the indicia comprises one or more of an image of the healthcare providerand a logo associated with the healthcare provider. In some embodiments,the healthcare provider application comprises a database comprising datasensed from a plurality of patients, and the healthcare providerapplication comprises a software module for organizing and segregatingthe data for each of the plurality of patents. In some embodiments, thepatient application and the healthcare provider application eachcomprise a software module for real-time video communication between thepatient and the healthcare provider. In some embodiments, at least aportion of the patient application is unlocked with an e-prescriptionthat is received. Described herein is a computer implemented methodcomprising: sensing a physical parameter of a patient with a sensor;transmitting one or more of the physical parameter and a patientcommunication that references the physical parameter; and transmittingto the patient an automatically generated communication in response toone or more of the physical parameter and the patient communication thatis transmitted; wherein the automatically generated communicationreferences one or more of the physical parameter and the communication;and wherein the automatically generated communication includes indiciathat it was sent by a healthcare provider. In some embodiments, thephysical parameter comprises a vital sign of the patient. In someembodiments, the physical parameter comprises a heart sound of thepatient. In some embodiments, the patient communication is transmittedaround a time that the physical parameter is sensed. In someembodiments, the patient communication comprises an audio recording ofthe patient. In some embodiments, the patient communication comprises avideo recording of the patient. In some embodiments, the patientcommunication is recorded and transmitted to the healthcare provider inreal-time. In some embodiments, the sensor is configured to operablycouple with a mobile computing device. In some embodiments, the sensoris integrated with the mobile computing device. In some embodiments, thesensor comprises two ECG electrodes. In some embodiments, theautomatically generated communication comprises a message ofencouragement or congratulation that is personalized to the patient. Insome embodiments, the indicia comprises one or more of an image of thehealthcare provider and a logo associated with the healthcare provider.In some embodiments, the method comprises receiving, by the healthcareprovider, data sensed from a plurality of patients, and organizing andsegregating the data for each of the plurality of patents using adatabase. In some embodiments, transmitting a real-time videocommunication between the patient and the healthcare provider. In someembodiments, the step of sensing the physical parameter requires firstreceiving an e-prescription from the healthcare provider.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the subject matter disclosed herein are set forthwith particularity in the appended claims. A better understanding of thefeatures and advantages of the subject matter disclosed herein will beobtained by reference to the following detailed description that setsforth illustrative embodiments, in which the principles of the subjectmatter disclosed herein are utilized, and the accompanying drawings ofwhich:

FIG. 1 shows an exemplary embodiment of a platform as described hereincomprising a digital processing device.

FIG. 2A shows an embodiment of an initial home screen interface apatient encounters when he or she has not yet signed into a patientapplication that is operating on a computing device as described herein.

FIGS. 2B-E show screenshots of exemplary interfaces of a patientapplication that are viewed by the patient once the patient logs in tothe patient application. FIG. 2B shows a screenshot of an exemplaryinterface for sensing an ECG; FIG. 2C shows a screenshot of an exemplaryinterface for sensing a heart rate of a patient; FIG. 2D shows ascreenshot of an exemplary interface for sensing a blood pressure of apatient; FIG. 2E shows a screenshot of an exemplary interface forsensing a weight of a patient

FIG. 3 shows a screenshot of an exemplary patient interface a patientencounters during the sensing of an ECG.

FIG. 4A shows a screenshot of an exemplary patient interface duringsensing of a physiologic parameter comprising a blood pressuremeasurement.

FIG. 4B shows an exemplary screenshot of a patient interface showingrecorded blood pressure measurements over a period of time.

FIG. 5 shows an exemplary screenshot of a patient interface 500displaying multiple historical physiologic measurements and includesanalysis and/or insights regarding the physiologic parameters.

FIG. 6 shows an exemplary screenshot of a patient application showing anexemplary healthcare provider communication.

FIG. 7 shows a screenshot of an exemplary patient interface on a patientapplication, wherein a patient is given a task that corresponds to apatient care plan.

FIG. 8 shows a screenshot of an exemplary healthcare providercommunication transmitted in response to received patient data.

FIG. 9A shows a screenshot of an exemplary initial home screen interfaceof a healthcare provider application as would be viewed by a healthcareprovider when browsing his or her list of patients using the healthcareprovider application.

FIG. 9B shows a screenshot of an exemplary interface of a healthcareprovider application displaying received data.

FIG. 9C shows a screenshot of an exemplary interface of a healthcareprovider application that allows a healthcare provider to select adescriptor of a received patient ECG.

FIG. 9D shows a screenshot of an exemplary interface of a healthcareprovider application that allows a healthcare provider to type inremarks relating to a received patient ECG.

DETAILED DESCRIPTION

The term patient” as used herein refers to a human that may use thesoftware platform disclosed herein. None of the terms require or arelimited to a situation characterized by the supervision (e.g. constantor intermittent) of a healthcare provider (e.g. a doctor, a registerednurse, a nurse practitioner, a healthcare provider's assistant, anorderly, or a hospice worker).

The terms “sensor” and “sensing device” includes any hardware configuredto sense a patient parameter including stand-alone sensors and sensorsthat include processors or additional computing and/or hardwarecomponents (e.g. transmitters or displays).

The term “operably coupled” includes coupling through an operativeconnection. Such coupling may further comprise a physical integration ora reversible coupling of components. Or, such coupling may be entirelybetween physically separate components.

Platforms

Described herein are software platforms (or “platforms”), systems,devices, and methods for providing effective healthcare to a patientwhile increasing the efficiency of the healthcare provider. A platformprovides effective healthcare to a patient through, but not limited to,monitoring of the physical parameters and therapeutic objectives of thepatient. In addition, a platform is further configured to provide acommunication link between a patient and a healthcare provider. Theplatform is configured so that a patient is provided with more directand timely access to a healthcare provider while at the same timenumerous monitoring tasks and/or communications from the healthcareprovider to the patient are automated saving the healthcare providertime and thereby increasing their efficiency.

A platform comprises one or more customized software applications (or“applications”) configured to interact with one another. Applications ofa platform as described herein are configured to provide monitoring andcommunication features.

In some embodiments of the platform, the platform includes one or morehardware components (e.g. one or more sensing devices).

In some embodiments, a platform is configured to operate together withone or more devices and/or one or more systems. That is, a device asdescribed herein, in some embodiments, is configured to run anapplication of a platform using a built-in processor, and in someembodiments, a platform is utilized by a system comprising one or morecomputing devices that interact with or run one or more applications ofthe platform. A method as described herein includes, for example, stepsfor connecting a patient and a healthcare provider using a platform asdescribed herein

A platform comprises one or more applications, wherein at least oneapplication comprises a patient application and one applicationcomprises a healthcare provider application. In some embodiments, aplatform comprises an additional monitoring application (i.e. inaddition to the patient and healthcare provider application) that islocated on a computing device at a remote monitoring location. Forexample, a third party, in some embodiments, has a monitoringapplication that allows the third party to monitor and/or interact withone or more applications of one or more platforms. For example, amonitoring service that monitors patient data would utilize a monitoringapplication.

FIG. 1 shows an exemplary embodiment of a platform as described hereincomprising a digital processing device 101. The digital processingdevice 101 includes either a patient application or a physicianapplication as described herein. The device 101 is configured to run theapplication. The digital processing device 101 includes a centralprocessing unit (CPU, also “processor” and “computer processor” herein)105, which is either a single core or multi-core processor, or aplurality of processors for parallel processing. The digital processingdevice 101 also includes either memory or a memory location 110 (e.g.,random-access memory, read-only memory, flash memory), electronicstorage unit 115 (e.g., hard disk), power source 125, and communicationinterface 120 (e.g., network adapter) for communicating with one or moreother systems, and peripheral devices 135. The memory 110, storage unit115, interface 120 and remote devices 135 are configured to communicatewith the CPU 105 through a communication bus (solid lines), such as amotherboard. The digital processing device 101 is, in some embodiments,operatively coupled to a computer network (“network”) 130 with the aidof the communication interface 120. The network 130, in someembodiments, comprises the Internet. The network 130 in some embodimentsis a telecommunication and/or data network.

The CPU 105 is configured to execute machine-readable instructionsembodied in a software application or module. The instructions may bestored in a memory location, such as the memory 110.

The storage unit 115 in some embodiments is configured to store files,such as user data, e.g., user preferences, and user programs.

Certain methods as described herein are implemented by way of machine(e.g., computer processor) executable code stored on an electronicstorage location of the digital processing device 101, such as, forexample, on the memory 110 or electronic storage unit 115. The machineexecutable or machine readable code is provided in the form of asoftware application or software module. During use, the code isexecuted by the processor 105. In some cases, the code is retrieved fromthe storage unit 115 and stored on the memory 110 for ready access bythe processor 105. In some situations, the electronic storage unit 115is precluded, and machine-executable instructions are stored on memory110.

In some embodiments, a remote device 135 is configured to communicatewith the digital processing device 101, and comprises any mobilecomputing device, non-limiting examples of which include a tabletcomputer, laptop computer, smartphone, or smartwatch. In someembodiments, a remote device 135 comprises a physiologic sensor.

The applications as described herein (i.e. patient application,healthcare provider application, and monitoring application) compriseone or more software modules. Software modules as described hereincomprise computer readable and executable code. In various embodiments,a software module comprises a file, a section of code, a programmingobject, a programming structure, or combinations thereof. In furthervarious embodiments, a software module comprises a plurality of files, aplurality of sections of code, a plurality of programming objects, aplurality of programming structures, or combinations thereof. In variousembodiments, the one or more software modules comprise, by way ofnon-limiting examples, a web application, a mobile application, and astandalone application. In some embodiments, software modules are in onecomputer program or application. In other embodiments, software modulesare in more than one computer program or application. In someembodiments, software modules are hosted on one machine. In otherembodiments, software modules are hosted on more than one machine. Infurther embodiments, software modules are hosted on cloud computingplatforms. In some embodiments, software modules are hosted on one ormore machines in one location. In other embodiments, software modulesare hosted on one or more machines in more than one location.

A computing device as described herein includes an operating system thatenables it to run the software applications of the disclosure.Non-limiting examples of such operating systems are: Android, iOS,Chrome, Windows 10 Mobile, Blackberry 10, Firefox OS, Sailfish OS,Tizen, Ubuntu Touch OS, and H5OS. Non-limiting examples of manufacturersthat produce said mobile computing devices compatible with the softwareapplications disclosed herein are: Apple, Samsung, Sony, HTC, LG, andMotorola Mobility.

Sensing Device

In some embodiments of a platform, one or more sensors (or “sensingdevices”) are configured to monitor one or more physiologic parametersof an individual. In some embodiments, a local sensing device, forexample, a sensing device located with a patient, is configured tocommunicate with one or more remote computing devices. As used here, aremote computing device is either a device not located with the patientor one that is not integrated with a computing device on which thepatient application is running.

A sensing device, in some embodiments, is integrated with a patientcomputing device. For example, a sensing device comprising one or moreECG electrodes is integrated into a housing and/or processor of acomputing device such as a smartphone or smartwatch. A sensing device,in some embodiments, operably couples to a patient computing device. Forexample, a sensing device having a coupler such as a magnetic oradhesive coupler is configured to couple with a computing device via themagnetic or adhesive coupler. In some embodiments, a sensing device isintegrated with a housing of a protective case for a smartphone. In someembodiments, a sensing device is integrated with a watch band of asmartwatch.

A sensing device, in some embodiments, comprises a stand-alone deviceconfigured to transmit data to a patient application and/or a healthcareprovider application. Non-limiting examples of sensing devicesconfigured to operate with the platform described herein includethermometers, heart-rate sensors, activity sensors (e.g. anaccelerometer, a gyroscope), location sensors (including positionsensors), blood pressure sensors, oxygen saturation sensors, weightsensors (e.g. a scale), sweat sensors (e.g. a capacitive sensor),respiration sensors, EEG sensors, and ECG sensors.

Patient Application

A patient application is configured to be operated by a patient and ahealthcare provider application is configured to be operated by ahealthcare provider. In some embodiments of the platform, a patientapplication is on a computing device that is located with the patientand is remotely located from a healthcare provider.

A platform is configured so that one or more patient applications arelinked to one or more health care provider applications. For example,data and communications are transmitted back and forth from patient tohealthcare provider and from healthcare provider to patient through oneor more applications of the platform. In certain embodiments, datareceived from a patient application results in a computer-generatedresponse from an application within the platform (e.g. a healthcareprovider application or a monitoring application).

A patient application is configured to monitor the health of a patientin either an episodic or continuous fashion. One manner in which thepatient application continuously monitors the health of a patient is inan embodiment in which a sensor is continuously worn, contacted, orotherwise engaged by a patient.

A patient application is configured to receive, organize, and/or trackpatient data including sensed physiologic parameters. For example, apatient application is configured, in some embodiments, to receive aheart rate of a patient from a heart rate sensor. For further example,in some embodiments, a patient application is configured to receive asensed ECG of a patient.

A patient application, in some embodiments, is configured to receivemultiple health metrics or physiologic parameters. For example, thepatient application comprises one or more interfaces presented to thepatient that allow for the sensing and receiving of several parameters.Non-limiting examples of sensed patient parameters received by a patientapplication include an ECG, blood pressure, heart rate, height, weight,age, and physical activity level.

The patient application, in some embodiments, is configured to providesimultaneous measurement and sensing of cardiac health data. Inaddition, the patient application, in some embodiments, is configured totransmit data (e.g. cardiac health data or notifications) to anotherapplication within the platform. Transmission of sensed data to anotherapplication within the platform occurs simultaneously to the sensing ofthe data in some embodiments of the platform.

In some embodiments, the patient application is configured to organizeand/or track data received from a sensing device, whereas in alternativeembodiments a second, possibly remote, application organizes and tracksdata received from a sensing device. Organizing received data on apatient application, in some embodiments, comprises sorting the data ina searchable patient interactive database. In some embodiments of thepatient application, tracking received data comprises monitoring forspecific data values or data ranges within the received data. In someembodiments, sensed data is transmitted directly to a healthcareprovider application without being transmitted to a patient application.

A patient application is configured to work on or in conjunction with acomputing device. For example, a first computing device comprises one ormore sensors (either physically integrated with the computing device ornot physically integrated with the computing device) configured to sensea physiologic parameter of a patient. For example, a patient may utilizean ECG monitor, a blood pressure monitor or a pulse oximeter, and thepatient application to record and save or store his or her cardiacelectric activity and blood pressure. Furthermore, the patient may electto send said cardiac electric activity and blood pressure data or oxygensaturation data to his or her healthcare provider via the softwareapplication of the disclosure. Furthermore, the patient application, insome embodiments, is configured to simultaneously monitor and/or recordmultiple physiologic parameters.

Sensed data is transmitted to an application of the platform (e.g.patient application, healthcare provider application, monitoringapplication) either through a wired connection wireless connection via,for example, a WiFi transmitter, a Bluetooth transmitter, an audio orultrasound acoustic transmitter.

A patient application comprises one or more interfaces (e.g. a graphicalinterface, an audio interface, a video interface). One or more patientinterfaces of the software applications enable the patient to: forexample, obtain physiological information from a sensing device or fromother health-based software applications (e.g. Apple Health), storesensed data from a sensing device, transmit and receive communications,track completion of tasks, and/or transmit physiological, audio, andvisual data to a healthcare provider.

In some embodiments of the patient application, the patient applicationis configured to communicate with another application running within theplatform described herein, and, in some embodiments, is also configuredto communicate with software applications that are not a part of theplatform in order to transfer and/or receive data such as height,weight, age, physical activity level, heart rate, blood pressure, and/orECG data from a sensing device. For example, in some embodiments, thepatient transfers to and/or receives data from other health basedsoftware applications including, but not limited to, Apple Health,Google Fit, S Health, and/or Fitbit and save it to his or her cardiacmonitoring device.

The patient application provides patients with one or more patientinterfaces that provide for selection by the patient of specific data tobe transmitted to a healthcare provider, and/or data that may betransmitted from the patient application to the healthcare providerautomatically. Data transmitted to a healthcare provider applicationfrom the patient application comprises, for example, height data, weightdata, age data, physical activity level data, heart rate data, bloodpressure data, and ECG data.

FIG. 2A shows an embodiment of an initial home screen interfaceencountered by a patient when he or she has not yet signed into apatient application that is operating on a computing device as describedherein. The patient application typically includes a log in feature 200that prompts the patient to provide, for example, his or her email andpassword in order to log in.

In some embodiments, either the entire patient application or a portionof the application is provided to the patient in a locked state, wherein order to operate the application or a portion of the application, apatient must first be granted access by another party (e.g. a healthcareprovider, hospital, employer, or insurance provider). For example, ahealthcare provider grants a patient access to the patient applicationby providing the patient with a traditional prescription or ane-prescription containing an access code or password through which apatient obtains access to the locked patient application or lockedportion of the patient application by entering the password as a loginand/or password in the login-in feature 200. In some embodiments of theapplications described herein, an e-prescription comprises an email sentfrom the healthcare provider to the patient (or caused to be sent by thehealthcare provider application to the patient) that contains an accesscode or password to access the software application. In another example,a healthcare provider provides an e-prescription comprising a hyperlinkthat when clicked on by the patient unlocks the patient application or alocked portion thereof. In another example, a healthcare provider sendsa patient a text message containing either a link or a code that is usedby the patient to unlock the patient application or a portion thereof.In some embodiments of the platform, access to the patient applicationis automatically granted by the platform in response to a request by ahealthcare provider.

In another example, a healthcare provider provides a patient with ane-prescription for a health monitoring device that utilizes and/orincludes a patient application as described herein. For example, ahealthcare provider provides a patient with a prescription for a devicethat is configured to run the patient application as described herein.For further example, a cardiologist provides the patient with ane-prescription for a device comprising electrodes that is configured tosense an ECG of the patient and interface with the patient applicationwhich was also prescribed to the patient.

Once a patient accesses the patient application by entering an accesscode or password provided by another party (e.g. a healthcare provider,hospital, employer, or insurance provider), the patient application, insome embodiments, displays an image associated with the healthcareprovider such as, for example, an image of a healthcare provider and/orone or more logos associated with the healthcare provider and/or thehealthcare provider's practice and/or a hospital associated with thehealthcare provider.

FIGS. 2B-E show screenshots of exemplary interfaces of a patientapplication that are viewed by the patient once the patient logs in tothe patient application. FIGS. 2B and 2C show a patient interfacecomponent 204 that provides the patient with the ability to select torecord an ECG or a heart using, for example, an ECG sensing device 200that is configured to interact with the software application. Thepatient interface component 204, in some embodiments, comprises atouchscreen button.

In some embodiments of the patient application, a patient interfacecomprises a dashboard 210 and/or interface 204, which the patientengages with in order to carry out a task such as sense, for example,one or more physiologic parameters using a sensing device such as, forexample, resting heart rate (FIG. 2C), blood pressure (FIG. 2D),physical activity, and weight BMI (FIG. 2E). In some embodiments, whenengaged by the patient, interface 204 causes the sensing of aphysiologic parameter of a patient by a sensing device 200, 206, or 208(which are depicted on the screen shot of the patient application in theexemplary embodiments of FIGS. 2B-E). First sensing device 200 comprisesa smartphone operably coupled to one or more ECG electrodes (not shown).As described herein, in some embodiments, a patient application isrunning on the first sensing device 200. A second sensing device 206comprises a blood pressure cuff and a third sensing device 208 comprisesa scale. As described herein, in some embodiments, a patient applicationreceives sensed data transmitted from a sensing device on which it isnot running such as, for example, embodiments of the second and thirdsensing devices 206 and 208.

FIG. 3 shows a screenshot of an exemplary patient interface a patientencounters during the sensing of an ECG—displayed on the interface at300—using an ECG sensing device. In some embodiments of the patientapplication, a patient is able to select an option in the patientinterface, for example, using a touchscreen button 306 that allows thepatient to record audio and/or video using a computing device that isinteracting with the patient application (e.g. a smartphone that isrunning the patient application as an app). For example, a patient maysense an ECG with an ECG sensing device, transmit the sensed ECG to aprocessor on a computing device (e.g. a smartphone or a smartwatch), andrecord an audio and/or video recording that the patient applicationassociates with the sensed ECG. For example, a patient may record anaudio recording that says “I'm having chest pain” together with a sensedECG. The patient application is configured to associate the sensed ECGtogether with the recorded audio and/or video recording and store themlocally on a computing device interacting with the patient applicationand/or transmit ECG and audio and/or video recording together to anothercomputing device (e.g. a computing device of a healthcare provider ormonitoring service). The patient interface component may prompt thepatient to verbally state any notes the patient has to add by, forexample, engaging the patient interface at 306 by touching thetouch-screen interface at 306. Once engaged at 306, for example, thepatient verbally describes any symptoms he or she is experiencing, forexample, during that day or while the ECG is being sensed. Such verbal(e.g. video or audio) description is recorded by the patient applicationand transmitted to a physician application and/or a monitoringapplication and/or stored. The addition of verbal notes by the patientto the ECG data provides for a correlation between symptoms and cardiachealth metrics. Heart rate displayed on the exemplary interface at 304and other parameters specific to ECG data such as filter, gain, andspeed are displayed on the ECG measurement interface at 302 in someembodiments or are provided as metadata.

A patient application, in some embodiments, displays sensed patient datavia a patient interface such as the exemplary interface displayed inFIG. 3. One or more health metrics displayed in the patient interfaceare displayed graphically or textually. The patient interface may alsodisplay an ECG at 300 and heart rate recordings at 304 over a period oftime; the ECG, heart rate recordings, and time may be displayedgraphically or textually.

The patient interface may further, for example, display the status of anECG measurement, wherein the status may reflect: a normal ECGmeasurement and may be labeled as “normal;” or an abnormal ECGmeasurement may be labeled as “atrial fibrillation.” In other aspects,the patient dashboard interface may enable the patient to add notes toeach recorded health metric

In some embodiments of the patient application, the data in the patientinterface of the patient application is also viewable by the healthcareprovider application. That is, in a platform wherein a healthcareprovider and a patient are running software applications on theirrespective computing devices, a healthcare provider, in some embodimentsof the platform, is able to view the patient's patient interface as itappears to the patient using the healthcare provider application runningon a computing device of the healthcare provider. Alternatively, thedata may be viewed in the healthcare provider application at time laterthan acquisition of the data.

FIG. 4A shows a screenshot of an exemplary patient interface duringsensing of a physiologic parameter comprising a blood pressuremeasurement. A sensing device, in some embodiments, comprises a bloodpressure monitor comprising an electronic sphygmomanometer configured tosense a patient blood pressure and transmit the sensed blood pressure tothe patient application. In some embodiments. a patient is prompted torecord a blood pressure measurement by the patient application throughthe transmission of an alert or alarm 400 displayed on the interface orotherwise transmitted through a computing device interfacing with thepatient application. The patient is then prompted, in some embodiments,to transfer the blood pressure recording from the blood pressure deviceto the patient application by, for example, engaging touchscreen button402, and furthermore, the patient may store said blood pressurerecording in a computing device via the patient application, whereas, insome embodiments, storage and transmission of a sensed parameter is doneautomatically.

As shown in FIG. 4B, which shows an exemplary screenshot of a patientinterface, a patient is able to view stored blood pressure recordingsover a period of time as depicted graphically at 404. The patientinterface shown in FIG. 4B further displays at 402 the most recentrecordings to the patients by labeling them as “new” and including thetime on which the blood pressure recording was saved. In addition, thepatient may view other metrics sensed over a period of time such as, forexample, stored weight and BMI recordings over a period of time.

FIG. 5 shows an exemplary screenshot of a patient interface 500displaying multiple historical physiologic measurements and includesanalysis and/or insights regarding the physiologic parameters. Forexample, interface 500 is configured in some embodiments to displaygraphical representation of one or more physiologic parameters sensedover time. For example, interface 500 is configured in some embodimentsto display an assessment of a sensed physiologic parameter such as ifthe sensed parameter is normal or abnormal.

FIG. 6 shows an exemplary screenshot of a patient application showing anexemplary healthcare provider communication 602. A communication to apatient through the platform is either sent directly from a healthcareprovider or is automatically generated and contains an indicia 600 thatit was generated by a healthcare provider (i.e. even though it wasgenerated automatically).

An automatically generated communication as described herein is acomputer generated communication yet it has indicia of having beencreated and transmitted by a healthcare provider. In this way, a patientis given the impression that a computer generated communication wascreated and generated by a healthcare provider. An example of a computergenerated communications includes a communication of congratulation to apatient for successfully completing a task such as, for example, losing5 pounds of weight. In some embodiments of the platform describedherein, a computer generated communication contains indicia that thecommunication was generated and transmitted by a healthcare providersuch as, for example, an electronic message containing an image of thehealthcare provider or a logo associated with the healthcare provider.It is very beneficial to automatically generate (i.e. computer generate)such communications rather than having a healthcare provider generatethem in that it saves the healthcare provider time in monitoring andresponding to routine patient monitoring changes. While at the same timethe indicia of the communication having originated from the healthcareprovider provides emotional benefits to the patient. Computer generatedcommunications are one way in which the platform as described hereinfunctions as a healthcare provider extender or assistant, saving thehealthcare provider time while providing valuable patient monitoring andfeedback.

The applications of the present disclosure also provide patients with apatient interface where the tasks provided by a healthcare provider arereceived and displayed. In this case, as shown in FIG. 6, a healthcareprovider has provided to the patient a care plan comprising of recordinghis or her weight.

The software application also provides an interface where pushnotifications sent by the healthcare provider are received anddisplayed. An additional interface component, in some embodiments,allows the patient to track or affirm completion of varioushealth-related tasks such as physical activity or taking medications.

FIG. 7 shows a screenshot of an exemplary patient interface on a patientapplication, wherein a patient is given a task 700 that corresponds to apatient care plan (in this case, the care plan of FIG. 6). Once thepatient engages with a scale, in some embodiments, pressing atouchscreen button 702 causes the transmission of data from the scale(while in others, the scale does so automatically), or alternatively thepatient inputs the weight data into the interface and affirms the databy selecting a button.

In some embodiments, a healthcare provider application is configured togenerate a comprehensive patient care plan using received patient data.The patient care plan, for example, is transmitted to a patientapplication and, for example, is configured to monitor, record, and/ortrack multiple health metrics in a patient such as ECG, blood pressure,weight, physical activity levels, BMI, and medication compliance.

The healthcare provider applications described herein, in someembodiments, are configured to provide a patient with the ability toperform an exercise stress test in order to test for the presence heartdisease. For example, a patient application instructs a patient toperform an exercise for a set period of time, such as walking on atreadmill for 20 minutes, while contacting an ECG sensing device that isin communication with the patient application, which, for someembodiments, transmits that data to the healthcare provider applicationfor analysis.

An exercise stress test is used to aid in the diagnosis ofcardiovascular disease. Specifically, the exercise stress test isperformed by a healthcare provider in a professional clinic or medicalcenter to determine the amount of stress that a patient's heart is ableto withstand before developing either evidence of ischemia or anabnormal heart rhythm. Different types of stress tests may comprise atreadmill or exercise stress test, dobutamine or adenosine stress test,stress echocardiogram, or nuclear stress test. An exercise stress testis used to measure the effect of exercise on the heart. An exercise testperformed in a professional clinic comprises monitoring a patient'scardiac electric activity as the patient walks on a treadmill. Thehealthcare provider monitors the patient's cardiac electric activity byplacing electrodes in ten small areas of the patient's body, which areconnected to an ECG monitor. The healthcare provider takes baselinemeasurements of blood pressure, ECG, and heart rate prior to commencingthe exercise stress test. The exercise stress test begins when thepatient starts walking on the treadmill for specific period of time. Ifany abnormal changes in the ECG or any chest pains develop, the test isstopped and such abnormal changes are noted.

In some embodiments, the patient application described herein mayprovide the patient with the ability to perform an at-home exercisestress test to test for heart disease. The patient may use the cardiachealth monitoring device and the patient application to monitor cardiacelectric activity, blood pressure, and heart rate while performing theexercise stress test. The patient application may instruct the patientto place a cardiac health monitoring device in contact with his or herskin, and take a baseline ECG measurement. The interface may furtherinstruct the patient to take a baseline blood pressure measurement priorto starting the exercise stress test. The patient application may havean interface that prompts the patient to begin an exercise stress test.The interface may prompt the patient to walk for a determined amount oftime while physically contacting the cardiac health monitoring device.For example, the patient may be using a smartphone or other mobilecomputing device, which incorporates sensing electrodes, as a cardiachealth monitoring device to perform the at-home exercise stress test.Furthermore, the patient may use said smartphone (or other mobilecomputing device) comprising sensing electrodes and may place his or herhands over said sensing electrodes while he or she engages in walking aspart of the exercise stress test. At the conclusion of the period oftime, the heart rate is measured over 2 minutes to calculate the timerequired for the heart to recover from the exercise. The interface maycomprise a component to provide the patient with the option to record,save, and/or send all data collected during the exercise stress test,once the stress test has been completed, which data may then betransmitted or shared with the healthcare professional in the healthcareprofessional application via transmitting means known to the skilledartisan.

FIG. 8 shows a screenshot of an exemplary healthcare providercommunication transmitted in response to received patient data. In thiscase, the patient having successfully completed the care plan of FIG. 6by recording and transmitting his or her weight as shown in FIG. 7receives a congratulatory message. As described, such a healthcareprovider communication is either generated and sent by the healthcareprovider or is generated and sent automatically, for example, by thehealthcare provider application.

As shown, an indicia 800 authenticates the healthcare provider generatedand transmitted the message and may include an image or logo of thehealthcare provider. A healthcare provider communication 802 isgenerated automatically, in some embodiments, when a patient achieves acertain goal as indicated by received sensed physiologic data. In thisexample, once a patient achieves a goal weight, a congratulatorycommunication 802 is automatically sent to the patient application. Insome embodiments, a patient communication references achievement of agoal or task, such as, for example, a patient sending an email to thehealthcare provider application that states that the patient achieved aweight loss goal. In some embodiments, a patient communicationreferencing a specific physiologic parameter or achievement of a task(e.g. weight loss) is analyzed by an algorithm that in responsegenerates an automatic healthcare provider communication.

As shown, in some embodiments, a healthcare provider communicationreferences the received sensed data that triggered the sending of thehealthcare provider communication. For example, a patient instructed tolose ten pounds and transmits data or a communication indicating that heor she has successfully done so receives a congratulatory messagereferencing the ten pound weight loss or weight loss generally.

In general, behavioral notifications may be sent by the healthcareprovider to a patient of their choice. The behavioral notifications sentto patients by healthcare providers may be automatically generated. Thenotifications sent to patients may be personalized push notificationsthat are automatically generated and sent to patients when patientscomplete a prescribed task. For example, a healthcare provider'sapplication may automatically generate and send a push notification to apatient congratulating a patient for achieving a prescribed task.Examples of prescribed tasks may be performing a physical activity,losing weight, decreasing BMI points, recording ECG data, and/orrecording blood pressure measurements.

Behavioral notifications may also be sent by a patient's family members.The software application of the disclosure may prompt the patient to“add” patients and connect with them via the software application. Thefamily members that accept and connect with the patients may receivenotifications when the patient achieves specific tasks such as correctlyadhering to their prescription regimen. The family members may send abehavioral notification congratulating the patient for achieving theirprescribed task.

Healthcare Provider Application

FIG. 9A shows a screenshot of an exemplary initial home screen interfaceof a healthcare provider application as would be viewed by a healthcareprovider when browsing his or her list of patients using the healthcareprovider application. In some embodiments of the healthcare providerapplication, the healthcare provider sorts his or her list of patientsby other healthcare providers' names or technician's′ name. In someembodiments of the software application, the initial home screeninterface comprises a “virtual stack” 900 displaying, for example, allECGs provided to the healthcare provider. For example, the interface mayprovide the healthcare provider with the option to select an ECG from avirtual stack of ECGs and view a 3 second segment of the ECG recording.The 3 second segment is displayed next to the reviewer and diagnosticinformation on the virtual stack 900. In some embodiments of thehealthcare provider application, the 3 second segment is selected to bethe ECG segment that is most representative of the diagnosis. Thedisplay of the entire ECG is used to quickly identify an ECG recordingfrom a list in the different subfolders of the virtual stack (e.g. “AllECGs,” “Abnormal,” “Normal,” “No Analysis,” or “Unreadable”).

A feature of the healthcare provider application, in some embodiments,is to receive and display patient data, as shown in FIG. 9A.Non-limiting examples of such patient data are height, weight, body massindex (BMI), age, physical activity level, heart rate, blood pressure,and/or ECG data. Patient data received by the healthcare provider isstored via the healthcare provider application in a computing devicerunning or connected to the healthcare provider application.Furthermore, the healthcare application aids the healthcare provider inanalyzing the data. For instance, the healthcare provider application,in some embodiments, comprises audio or video data analysiscapabilities.

A healthcare provider application is configured to receive, organize,and/or track patient data received from one or more patient applications(e.g. from one patient or a plurality of patients). As shown in FIG. 9Bat 902, a healthcare provider application is configured, to analyze andorganize received ECG data (i.e. indicate if analysis reveals a possibleabnormality).

The healthcare provider application is configured to analyze receivedpatient data. For example, in some embodiments, a healthcare providerapplication is configured to calculate and generate risk scores based onpatient population data. For example, a risk score may be calculated topredict the likelihood of an individual to suffer from cardiovasculardisease in the future. Such algorithms, for example, use physiologicaldata, such as ECG data, to recognize a patient's identity based onpatient population data or to recognize a change in patient's healthbased on historical data for the patient. The software application maycomprise machine learning algorithms, which improve analysis of anindividual's data based inputting that data into a machine learningalgorithm trained to predict health outcome probabilities for any numberof health conditions. In addition, such algorithms may provide withunique identification of individual patients based on analysis ofaggregate data such as ECG recordings or measurements. Uniqueidentification of patients by machine learning algorithms may compriseidentification of gender, identification of individual, identificationof change in health, and/or identification of heart age. In someembodiments of the software application, heart age may be arepresentative age of a patient's heart that reflects the overall healthof the patient's heart and a general indication of the patient's cardiachealth. Similar to heart age, machine learning algorithms may also serveas a risk assessment tool to calculate a risk score used to predict thelikelihood of an individual to suffer from cardiovascular disease in thefuture or to give the patient an overall perspective of their currentcardiac health status. Machine learning algorithms may be used topredict a risk score and/or predict a change in health, whether negativeor positive.

The healthcare provider's inbox interface may contain different folders,such as, but not limited to: a “triage” folder, a “healthcareprovider's” folder, a “confirmed and archived” folder. The healthcareprovider may move and organize data, such as patient's data, in saidfolders.

The healthcare provider application may alert the healthcare provider ifcertain data are received. For example, an interface of the healthcareprovider's software application may show a list of notificationsdisplaying information such as the patient's name, gender, age, phonenumber, and corresponding status update. In some embodiments of thesoftware application, a status update may comprise a notificationregarding a patient's ECG recording or the percentage of abnormal ECGdata of a patient. Other examples of patient status updates that thehealthcare provider may choose to activate notifications for are:possible atrial fibrillation detected, possible atrial fibrillationdetected with heart rate surpassing a customizable number, heart ratesurpassing a customizable number, heart rate under a customizablenumber, and no ECG data received in a customizable number of days. Thefrequency in which notifications are sent may be set to differentparameters such as never, once, or always.

In some embodiments of the software applications described herein, thehealthcare provider may add an interpretation to each ECG recording fromthe available options, which include: Sinus Rhythm, Sinus Brady, SinusTach, SVT, Atrial Fibrillation, Atrial Flutter, Paced, Junctional, VTach, or Unreadable, as shown in FIG. 9C. As shown, in some embodiments,a highlighting tool 904 allows a healthcare provider to select aparticular ECG segment, and an interactive check-box formatted list 906allows a healthcare provider to choose an assessment of the highlightedECG.

In some embodiments of the healthcare provider application, thehealthcare provider may also add an optional note to an ECG recording byselecting the “Add Optional Note” option 908 as illustrated by FIG. 9D.The healthcare provider application interface may provide for selectionby the healthcare provider to adjust and/or select which types of statusupdates may be assigned to be notified. The software applicationinterface may display the healthcare provider's total number of patientsthat are currently using the software application and have connectedwith the healthcare provider. An interface component provides forselection by the healthcare provider to add a new patient and send aninvitation code via email. The healthcare provider may also send anelectronic prescription for a cardiac health monitoring device or forregular cardiac health monitoring. The software application interfacemay display the healthcare provider's total number of patients that arecurrently pending acceptance of the healthcare provider's invitation touse the software application.

Notifications may not only be received by the healthcare provider, butthey may also be sent by the healthcare provider to a patient of theirchoice. The notifications sent to patients may be automaticallygenerated. The notifications sent to patients may be personalized pushnotifications that are automatically generated and sent to patients whenpatients complete a prescribed task. For example, a healthcareprovider's software application may automatically generate and send apush notification to a patient congratulating a patient for achieving aprescribed task. Examples of prescribed tasks may be performing aphysical activity, losing weight, decreasing BMI points, recording ECGdata, and/or recording blood pressure measurements.

An additional interface of the healthcare provider's application maycomprise a viewable, interactive patient directory or database. Thepatient directory or database may comprise a list of all patients thatmay be currently pending or may have accepted the healthcare provider'sinvitation to begin using the cardiac health monitoring softwareapplication. The patient directory may further display patientinformation such as name, phone number, age, gender, and an indicationof whether or not they are connected and are using the cardiac healthmonitoring software application. Furthermore, the interface may alsocomprise a component to provide the healthcare provider with the optionto electronically prescribe a cardiac health monitoring device and/orcardiac health monitoring. Such interface component may be placed inclose proximity to the patient's name for ease of accessibility.

The interface may also comprise a component to provide the healthcareprovider with the option to add a new patient. This interface componentmay be displayed in the patient directory interface of the softwareapplication. Upon selection by the healthcare provider, the “add newpatient” interface component opens up a new interface. Such newinterface may prompt the healthcare provider to enter potential newpatient information such as patient medical record number, first name,last name, email address, mobile phone number, date of birth, andgender. Once the healthcare provider decides to add a new patient he orshe may select the option to prescribe the cardiac health monitoringapplication as displayed on the interface. Moreover, once the cardiachealth monitoring application is prescribed, the software applicationmay automatically generate and send an email and a text message to thenew patient instructing them on how to operate the cardiac healthmonitoring software application. The interface may also comprise acomponent to provide the healthcare provider with the option to selectthe length of time the healthcare provider monitors a patient and theamount of money charged per month to said patient. The automaticallygenerated email may comprise an activation or referral code for thepatient to use in order to obtain access to the software application.

An additional interface of the healthcare provider application maycomprise an interactive interface to quickly view or scan relativedistances between the R-R peaks in an ECG recording. The interface, insome embodiments, provides an array of R-R peak distances displayed byhorizontal lines that the healthcare provider may interact with byclicking on each horizontal line. When the healthcare provider clicks ona horizontal line representing an R-R peak distance, the interfaceautomatically zooms in on the segment of the ECG recording thatcorresponds to such R-R peak distance. In this manner, the interactiveinterface allows for the healthcare provider to quickly scan multipleR-R peak distances.

The platform, in some embodiments, provides different payment plans inorder to obtain access to the disclosed software application. Forexample, a healthcare provider may purchase the software application,while a patient may purchase the health monitoring device associatedwith the software application, and the healthcare provider may bill thepatient a recurrent fee for utilizing the software application. In someembodiments of the software applications, systems, devices, and methodsdescribed herein, a healthcare provider purchases the softwareapplication, while a patient purchases the health monitoring deviceassociated with the software application, and the company selling thehealth monitoring device may bill the patient a recurrent fee forutilizing the software application. In some embodiments of the softwareapplications, systems, devices, and methods described herein, aninsurance company may offer a patient a free trial period wherein thepatient may be offered the health monitoring device associated with thesoftware application and the software application at no monetary chargefor a specific time period; upon termination of said time period, thepatient may elect to purchase the health monitoring device and thesoftware application. The patient may be presented with the option toupgrade to a “Pro” or “Premium” membership plan wherein the patient maybe charged a higher fee than the normal membership plan fee. The “Pro”or “Premium” plan may comprise access to a care plan. The care plan maycomprise automatically- or healthcare provider-generated tasks for thepatient to complete and reminders to complete such tasks. Such tasks maybe based on the patient's current health status and may provide specifichealth goals to meet.

Billing Features

The platforms, devices, systems, and methods described herein, in someembodiments, provide payment and billing features for patients andhealthcare providers. For example, a healthcare provider may purchasethe platform, while a patient may purchase the health monitoring deviceassociated with the platform, and the healthcare provider may bill thepatient a recurrent fee for utilizing the platform. Some of the paymentand billing features described herein, provide a healthcare provider theability to purchase a platform (such as the platforms described herein),while a patient is provided the ability to purchase the healthmonitoring device having a platform incorporated therewith. In thisembodiment, the company selling the health monitoring device may, forexample, bill the patient a recurrent fee for utilizing the platform. Insome embodiments of the platform of the payment and billing features, aninsurance company offers a patient a free trial period wherein thepatient may be offered the health monitoring device associated with theplatform and the platform at no monetary charge for a specific timeperiod; upon termination of said time period, the patient may elect topurchase the health monitoring device and the platform.

The platforms, devices, systems, and methods may include different typesof payment and billing methods for patients and healthcare providers.For example, a healthcare provider may purchase the platform, while apatient may purchase the health monitoring device associated with theplatform, and the healthcare provider may bill the patient a recurrentfee for utilizing the platform. In another aspect, a healthcare providermay purchase the platform, while a patient may purchase the healthmonitoring device associated with the platform, and the company sellingthe health monitoring device may bill the patient a recurrent fee forutilizing the platform. In some embodiments of the platform, aninsurance company may offer a patient a free trial period wherein thepatient may be offered the health monitoring device associated with theplatform and the platform at no monetary charge for a specific timeperiod; upon termination of said time period, the patient may elect topurchase the health monitoring device and the platform.

The patient may be presented with the option to upgrade to a “Pro” or“Premium” membership plan wherein the patient may be charged a higherfee than the normal membership plan fee. The “Pro” or “Premium” plan maycomprise access to a care plan. The care plan platform interface mayprompt a healthcare provider to automatically or manually generate tasksfor the patient to complete. The platform may automatically generatereminders for the patient to complete such tasks. Such tasks may bebased on the patient's current health status and may provide specifichealth goals to meet. The care plan interface may comprise the option toconnect with family members via the platform, optionally alert thefamily members of the status of the patient's cardiac health, andoptionally alert the family members of the status of the patient's taskcompletions. The care plan platform may enable family members toautomatically or manually send behavioral notifications to a patientupon successful completion of prescribed tasks such as correctlyfollowing a medication dosage regimen.

While preferred embodiments of the present invention have been shown anddescribed herein, it will be obvious to those skilled in the art thatsuch embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. It should be understoodthat various alternatives to the embodiments of the invention describedherein may be employed in practicing the invention. It is intended thatthe following claims define the scope of the invention and that methodsand structures within the scope of these claims and their equivalents becovered thereby.

What is claimed is:
 1. A platform comprising: a. a patient applicationcomprising: i. a software module for receiving sensed data from a sensorconfigured to sense a physiologic parameter of a patient; ii. a softwaremodule for transmitting one or more of the sensed data and a patientcommunication to a healthcare provider; iii. a software module forreceiving a healthcare provider communication; b. a healthcare providerapplication comprising: i. a software module for receiving one or moreof the sensed data and the patient communication; ii. a software modulefor generating the healthcare provider communication and transmittingthe healthcare provider communication to the patient; wherein thehealthcare provider communication is automatically generated andtransmitted in response to one or more of the sensed data or a patientcommunication that references the sensed data; wherein the healthcareprovider communication references the sensed data; and wherein thehealthcare provider communication includes an indicia that thehealthcare provider communication was generated by the healthcareprovider.
 2. The platform of claim 1, wherein the physical parametercomprises a vital sign of the patient.
 3. The platform of claim 1,wherein the physical parameter comprises a heart sound of the patient.4. The platform of claim 1, wherein the patient communication istransmitted around a time that the physical parameter is sensed.
 5. Theplatform of claim 4, wherein the patient communication comprises anaudio recording of the patient.
 6. The platform of claim 4, wherein thepatient communication comprises a video recording of the patient
 7. Theplatform of claim 4, wherein the patient communication is recorded andtransmitted to the healthcare provider application in real-time.
 8. Theplatform of claim 1, comprising the sensor and wherein the sensor isconfigured to operably couple with a mobile computing device.
 9. Theplatform of claim 8, wherein the sensor is integrated with the mobilecomputing device.
 10. The platform of claim 8, wherein the sensorcomprises two ECG electrodes.
 11. The platform of claim 1, wherein thehealthcare provider communication comprises a message of encouragementor congratulation that is personalized to the patient.
 12. The platformof claim 1, wherein the indicia comprises one or more of an image of thehealthcare provider and a logo associated with the healthcare provider.13. The platform of claim 1, wherein the healthcare provider applicationcomprises a database comprising data sensed from a plurality ofpatients, and the healthcare provider application comprises a softwaremodule for organizing and segregating the data for each of the pluralityof patents.
 14. The platform of claim 1, wherein the patient applicationand the healthcare provider application each comprise a software modulefor real-time video communication between the patient and the healthcareprovider.
 15. The platform of claim 1, wherein at least a portion of thepatient application is unlocked with an e-prescription that is received.16. A computer implemented method comprising: sensing a physicalparameter of a patient with a sensor; transmitting one or more of thephysical parameter and a patient communication that references thephysical parameter; and transmitting to the patient an automaticallygenerated communication in response to one or more of the physicalparameter and the patient communication that is transmitted; wherein theautomatically generated communication references one or more of thephysical parameter and the communication; and wherein the automaticallygenerated communication includes indicia that it was sent by ahealthcare provider.
 17. The method of claim 16, wherein the physicalparameter comprises a vital sign of the patient.
 18. The method of claim16, wherein the physical parameter comprises a heart sound of thepatient.
 19. The method of claim 16, wherein the patient communicationis transmitted around a time that the physical parameter is sensed. 20.The method of claim 19, wherein the patient communication comprises anaudio recording of the patient.